Female/Male Urinary Incontinence

Bladder control problems range from urinating too frequently to actual urine leakage (urinary incontinence). These problems affect millions of people of all ages and both sexes. Unfortunately, many people feel so ashamed that they may even hide their problem from their doctor. If your incontinence interferes with your daily life, seek help promptly. Our experienced urologists can recommend many new treatments to cure or manage your problem, letting you resume a normal life free from worry and shame.

There are several types of incontinence and some people experience more than one kind.

Urge Incontinence (Overactive Bladder) — in this type, urine leaks when the bladder inappropriately contracts, and you may not be able to get to the bathroom quickly enough.

Stress Incontinence — this type is most common among middle aged and older women. Exercising, coughing, sneezing or other activities put pressure on a weakened bladder sphincter and cause leaks.

Overflow Incontinence — in this type, which mostly affects men, you don't feel the urge to urinate, your bladder doesn't empty well and small amounts of urine may leak continuously.

Urge Incontinence (Overactive Bladder)

Symptoms

A sudden, strong urge to urinate

Inability to get to the bathroom in time

Frequent need to urinate, including at night

Feeling the urge to urinate when you hear water running

Leaking urine when you stand up after sitting

Causes

Most commonly this disorder is due to changes in the bladder muscle and pelvic nerves.

A diet high in bladder irritants such as coffee, tea, chocolate or acidic fruit juices can worsen the symptoms

Stress Incontinence

Symptoms

Causes

Most commonly this disorder is due to weakness in the pelvic floor muscle. This weakness is worsened by:

childbirth

menopause

previous pelvic surgery (i.e. hysterectomy).

Overflow Incontinence

Symptoms

Patients often feel that their bladder never completely empties. Many may note a frequent urge to urinate, but have difficulty initiating a stream.

Most patients note a constant, slow leaking through the day that worsens with cough, sneeze, and other physical activities

Causes

Benign prostatic hyperplasia{?} (BPH) — an enlarged prostate can interfere with the passage of urine through the urethra, the tube connected to the bladder

Damage to nerves near the bladder causing under-activity. This can occur with neurological injury or with diseases such as diabetes.

Urinary stones or bladder cancer

Side effects from medication

Diagnosis

The first step is a thorough history and physical by your doctor, who will examine your abdominal and genital area carefully. Additional tests may include:

Bladder diary — your doctor may ask you to keep a record of what you drink and your urine output

Urinalysis

Blood tests

More specialized tests that your urologist may perform include:

Postvoid residual test (PVR) — your doctor can determine how well you empty your bladder by using an ultrasound that detects the amount of leftover (residual) urine. A large amount may indicate a blockage, or a nerve or muscle problem.

Cystoscopy — a tiny instrument called a cystoscope is inserted into the urethra to look for and possibly remove abnormalities.

Treatment

Treatment will depend on your type of incontinence and its cause. Thankfully, most people can be treated successfully, allowing them to enjoy a normal life again. Your doctor may start with less invasive treatments first, such as behavioral changes or medication, and then use medical devices or surgery if other treatments don't adequately address your incontinence. Urinary tract obstruction usually must be treated surgically; however, those caused by prostate enlargement maybe treated with medication.

Lifestyle Changes (improvement may take time)

Fluid and diet management — avoid caffeinated or tomato-based food and drink, and drink adequate water

Bladder retraining — follow a schedule for bathroom trips and gradually increase the length of time between them to improve your bladder control

Bowel management — avoiding constipation with the help of fiber, stool softeners, as well as laxatives.

Biofeedback — can help you determine when you're exercising the right muscles

Special absorbent pads and underwear — these have improved in recent years and can help you feel more confident, especially while undergoing diagnosis and initial treatment

Medications

If you have urge incontinence, your doctor may prescribe medicine to relax your bladder muscles.

If you urinate frequently at night, you may need a medication that helps your body make less urine at night.

Surgery and Implanted Devices

Bulking agent — for stress incontinence, your doctor may inject a thick substance called a bulking agent into the area around the bladder to support it. This outpatient procedure takes about 5-10 minutes.

Electrical device — this outpatient procedure entails placement of a small electrode that delivers a mild electrical signal to the pelvic nerves to reduce leakage.

Sling surgery — a minimally invasive surgery that takes about 20-30minutes. A small strip of tissue or mesh is implanted under the bladder to support the bladder neck and urethra.

Artificial Urinary Sphincter — this implanted device replaces the natural muscle that controls the urine flow at the outlet of the bladder. This works best for men who suffer from significant stress incontinence due to failure of their urinary sphincter muscles.